Claims Adjudicator II

Spokane WA

Description

The Claims Adjudicator II works as part of a team that provides Workers Compensation Claims Management services to employers in a Retrospective Rating Program environment. This position focuses on light duty and return to work by communicating with employers, medical providers, and Washington States Department of Labor and Industries. It includes follows up to obtain the appropriate information and documents per department standards. It receives support and coaching from the Senior Claims Representative. This is generally work from home with some time in the Seattle office or regional hubs, and applicants in WA/OR/ID are encouraged to apply. Applicants must be authorized to work for any employer in the US. We are unable to sponsor or take over sponsorship of an employment Visa at this time. All new hires are required to have received a COVID-19 vaccination as determined by the CDC unless a reasonable accommodation is approved. Typical work for a Claims Adjudicator II: - Focuses on timely return to work on all claims in case load. - Investigates, analyzes, and determines insurance liability of workers compensation injury claims in accordance with state regulations. - Continually audits claims within assigned case load to verify L&Id eterminations have been made in accordance with state regulations, and that all relevant and proper documentation is contained in the state insurance file and the internal claims management system. - Identifies inaccuracies and filing of protests under the general direction and guidance of the Senior Claims Representative. - Utilizes on-line access to state claim files - Utilizes and maintains electronic document files containing confidential and privileged information. - Utilizes claims management software for independent report generation and analysis for caseload management. - Provides back-up to Adjudicator I, due to absences with regard to new file generation, daily data entry, processing and distributing daily incoming LNI mail, and phone coverage as well as completion and submission of Stay At Work Wage Reimbursement Applications - Other duties, responsibilities, and activities may change or be assigned at any time with or without notice. You'll bring the ability to: - Prioritize with accuracy in a fast-paced environment - Follow department practices and procedures and make suggestions for improvement. - Write clear and grammatically correct emails and claims reviews/plans of actions. - Communicate efficiently and effectively with team members. - Provide high quality, accurate and timely service to members. You'll need to have: - Previous insurance claims processing experience - one year minimum is preferred - High School diploma, or equivalent - Experience with a retrospective rating program preferred - Experience with return to work preferred - Medical admin background preferred Archbright offers:  Generous PTO and paid holidays, workout facility, medical, dental, vision benefits, 401K with match, flexible work schedule, short- and long-term disability, life insurance and more. To apply please go to: and click on Open Positions. From there you can review the Claims Adjudicator II to apply, or go directly to the application at: About Archbright and working here: Archbright is the go-to resource for Employers in Washington, Idaho, and Oregon.  At our core, we offer HR Advice and Legal Counsel through annual Membership. Our focus is helping Members elevate workplace performance—by helping to be compliant with the hundreds of employment laws and to build a more engaged workforce. Our mission is to tackle the complexities of the workplace, so Members can focus on the passion of their business.    At Archbright, we see diversity as everything that makes an employee who they are, and we believe our individual backgrounds, perspectives, and passions help us grow and solve problems that move us all forward.  The Archbright values of grit, fun, and inclusion drive our employees to engage, transform and deliver.